Use of Courthouse/Grounds Application

Application for use of Courthouse/Grounds

Pike County Board of Commissioners
Contact *

Responsible Person

Street Address

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Date *

Month Day Year
Date
Date *

Month Day Year
Date
Event Time *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Group requesting use: *
Name of event: *
Type of event: *
Specific areas of use: (grounds, porch, bldg.) *
Open to general public? (Yes or No) *
Number expected? *
Equipment to be used on grounds (chairs, tables, electrical, etc.) *
When will equipment be setup/taken down? *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Will food be served? (yes or no) *
For a fee? (yes or no)
Has this group used Courthouse/Grounds for other events? (yes or no) *
Were any problems encountered?
What dates and/or problems?
Signature of Responsible Party *

Clear
Date

Month Day Year
Date
Should be Empty:

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